Message from President 2. What is Full Face Imaging 3. Working with Full Face Imaging 4. Imax-Easy (Owandy) 5. Panoramic Examination 11-15

Transcription

1 Table of Contents Message from President 2 What is Full Face Imaging 3 Working with Full Face Imaging 4 Imax-Easy (Owandy) 5 Software (Apteryx) 6-10 Panoramic Examination Remote Control 12 TMJ1 Examination TMJ2 Examination Sinus Examination 23 Supplies 24 Assignment 25

2 2 of 17 Dear Dentists, Thank you for investing in the Ashtel Dental product. Today one of our trainers will walk you through a step by step procedure on how to use your new system. Your Training Specialist has spent numerous hours in preparation to show you how to utilize every feature of your new Digital System. Every Ashtel Dental employee understands the importance of the investment you have made and we are committed to work hard and help you maximize your knowledge of this state of the art system. Background of Ashtel Dental I started this company in 2002 as a technology consultant, specializing in setting up computer networks, running cables, and installing hi-tech equipment. The following year we decided to expand our line of products by adding a few intra oral cameras, and soon we ventured into digital sensors and digital panoramic machines. The latest addition to our growing line of products is the new Tomo machine for 3D imaging. Due to my hands on experience and vast exposure to the latest technology in the field, I have learned to understand and take advantage of the many benefits when it comes to digital products in the dental office. Naturally I passed this knowledge on to my team, emphasizing the importance of customer service and how our products can improve any dental practice and its productivity. I believe harnessing this knowledge and sharing it has given our company the leverage to grow at such a rapid rate, especially from direct referrals we receive from our existing customers. I am a firm believer of customer service and I will make sure you are completely satisfied with our product, before and after the purchase. If for any reason you are not satisfied or run into any issues please don t hesitate to pick up the phone and dial me direct at x 101. We specialize in digital dental solutions and have focused our energy and resources to make sure we are the best, so you can be your best. Welcome to the Ashtel Dental team and enjoy the journey with us. Sincerely, Anish Patel CEO Ashtel Dental x101

3 3 of 17 What is Full Face Imaging Full Face Imaging is a new technique which allows you to create a Full FMX from one Digital Panoramic image on a computer screen. Imaging software like Apteryx has now been developed to directly address patient discomfort or pain factor involved when using digital sensors and film. Most importantly the implementation of this technique reduces the overall exposure a patient is subjected to, in comparison to the conventional routine of capturing 18 images with a wall mounted x-ray. The Imax-Easy Pano machine, which is connected to your computer, now acts as your one sensor to create highly detailed and precise images. The Apteryx software, which can exist on any computer on your network, gives you the power to enhance, modify and print any image at any time. This highly diagnosable quality image is the first step to completing an FMX. If you are familiar with programs like MSWord or MSPaint, you will see a similarity when creating a Full FMX with Apteryx. In this case the Pano captures a digital image and Apteryx software helps you piece together the FMX. With a digital Pan you don t need to reposition a sensor or film to capture 18 images. One 17 second scan and your skills with a computer and mouse is all you need to complete a Full FMX. With Conventional digital and film radiography: You use your x-ray head 18 times to create an FMX You use uncomfortable and sometimes painful positioning devices You use a routine which can take anywhere from 5 to 10 minutes You use different sized sensors or film With Full Face Imaging: You use a Digital Pan to produce images instead of sensors or film There is NO discomfort or pain for the patient whatsoever The Pan completes one scan in 17 seconds You use a quicker routine enabling you to see more patients The key benefits with Full Face Imaging: Dose reduction to the patient No discomfort or pain for the patient Real time image acquisition No waiting time for film processing Image processing possibility Quicker Routine More engaging treatment education Quick access to images and available at any computer No more lost x-rays!

4 4 of 17 Working with Full Face Imaging In a few hours you will be taking Full Face Digital Panoramic Images with ease, and on your way to developing a new skill you ll have for the rest of your career. Your patients will become more engaged, comforted, and when they see you are providing the best possible treatment care with advanced technology they will surely be impressed. The routine of taking panoramic images with the Imax-Easy is similar to most other Pano machines on the market today. Patient Positioning plays a key roll in capturing quality images and our trainers will get your staff up to speed fast. The Pano machine connects to your computer, and your images will appear instantly on your screen saving you the time to reposition a sensor for the next shot. 17 seconds per scan and the patient is done, no more sensor or film discomfort, no more addition radiation exposure for the patient or you. The rest is just copy and paste to create a Full FMX. After working with a few patients on the Imax/Aptreryx system your routine will settle in and your patient count per day will increase. Introducing your new Digital Panoramic system to your patients is an opportunity to take advantage of. Explaining that chemicals are no longer needed, radiation exposure is greatly reduced and the elimination of discomfort by sensors or film in the mouth are benefits everyone will appreciate. When they see their image instantly pop up on your computer screen you ll be getting wows from the patient chair, and your treatment education process will be much more effective. Maintenance of your Imax-Easy Panoramic system Components of the Imax-Easy Digital Pan System are made with high quality materials. No specific maintenance of the system is required. Normal care and maintenance will result in many years of service. The external surfaces of the Pan machine should be kept clean by wiping with a slightly damp cloth occasionally. Do not immerse sensors in any liquids or disinfectants. Surfaces can only be cleaned by wiping with the disinfectant chemical. To avoid damage to the sensor cable, avoid kinking and severe bending. Damage to the USB Docking Station may occur if disturbed. Safety and Handling Precautions The Pan machine components comprise of a high quality electronic system that will withstand normal use, but must be treated with care and reasonable caution. Certain precautions must be observed so as not to void the warranty. Interference from metal objects such as a piercing, an earring, necklace or zipper must be removed at all times before scanning to prevent ghost imaging and radiation scatter. *Refer to your Ashtel Trainer for detailed positioning and maintenance info.

5 5 of 17 Your Imax-Easy Pano The Digital Panoramic Image quality is the result of your new Owandy equipment, proper Patient Positioning and your computer working together. Your Owandy equipment Pano Standard Adult or Child Panoramic, TMJ mouth open or closed and sinus. Positioning Please refer to your Ashtel Training Representative. Connection Box (USB Box) The USB box connects your Imax to your computer. Always be conscious that a cable is connected to the unit which you need to keep out of your path when accessing the surrounding area. Software (Apteryx/XrayVision) Apteryx is the name of the program you will be using to create and access your digital panoramic images for your Full FMX. If you are using a practice management program, both programs will now work together to access any patient file from any workstation connected to the network. Once you are familiar with Apteryx, creating your FMX will be quick and easy, just like cut and paste. Apteryx also gives you the flexibility to enhance any panoramic image in seconds, with one click of a button. Treatment Room Equipment For your digital Pan system to produce the best possible results, your Imax-Easy and computer, need to be in proper working order, and at the recommended settings. X-Ray heads: Pan units vary in quality. The Owandy Imax-Easy provides consistent, precise image quality, and may detect imperfections which previously did not appear on your films. Please be aware that in order to fully utilize capabilities of your Imax Pano and your Apteryx software, proper patient positioning is essential. Remember, only one 17 second scan is needed to capture an image, this means less exposure for the patient. Please go to the Ashtel web site, or contact the Ashtel technical services team for any additional information on recommended daily techniques and routines for Full FMX, Patient Positioning and Image Enhancing. Computer Monitors: Computer monitors vary greatly in quality. Low quality monitors and many LCD-type laptop monitors can degrade a digital image. Digital panoramic systems are extremely accurate, and a poor computer display will reduce the effectiveness of any digital radiography system. Computer screen resolution settings can be changed: Please do not lower your monitor settings from the minimum 1024x768 resolution / 32 bit color requirement which helps you make most of your high resolution Owandy mega-pixel sensor. Computer Graphic Cards: Inside your computer where the computer monitor connects with your computer is your graphics card. Older graphic cards may produce less than desirable image quality, even if you have a new monitor. New computers don t necessarily have acceptable graphics cards, so if you are purchasing new computer equipment, spend a little extra on a quality graphic card.

6 6 of 17 Software Opening a Patient in your Apteryx System Without linking patient names to your practice management program. 1. From your desktop screen Select the XrayVision icon Your Imaging Program will open. 2. Select Patient from your menu bar. ^ (menu bar starts in the upper left corner and starts with File ) 3. Select Open Patient (this will open the Patient Index menu) 4. Enter patients name, or first letters of each name. (a list of patients will appear) 5. Single click patients name. (your patients name will roll to the front of the index) 6. Select Open Patient in the upper right corner of the menu. Your patient file is now open and ready to take or view images. (You know your patient file is open when their name appears in the upper left corner above the menu bar.) With linking patient names to your practice management program use the Bridge. To open a patient in XrayVision automatically from your practice management program you must first have your patient open in the appropriate screen of your practice management program. Consult your practice management company if you are not sure. If your patient has previously been loaded into XrayVision: 1. Select the XV button in the upper right hand corner of the main toolbar and your patient will automatically link. Your patient file is now open and ready to take or view images. (You know your patient file is open when their name appears in the upper left corner above the menu bar.) If your patient has not previously been loaded into XrayVision: 1. Select the XV button in the right hand corner of the main toolbar and your patient will automatically link. 2. The next menu will state The Following Patient Does Not Exist (this is because this is the first time your patient has been loaded into Apteryx). Select Yes Create the Patient 3. Select ADD. (do not choose Add From External Database ) Your patient file is now open and ready to take or view images. (You know your patient file is open when their name appears in the upper left corner above the menu bar.) Taking a Single Panoramic Image in a mount 1. From the main toolbar Select Capture Layout

7 7 of 17 Software 2. From the Select Layout menu Double Click on the FMX#18 Pano Layout. 3. From the Capture Layout menu, highlight tile #19 whole mouth. 4. Select Take/Retake From and then Select Sensor

8 8 of 17 Software 5. From the Capture Sensor Image window, Select Owandy IMAX and then select OK. 6. Confirm a green sensor ready toolbar and set the Pano exposure by using the IMAX remote on the screen and the handheld. 7. Position patient properly consult with your Ashtel Trainer for details. 8. Execute Exposure with remote and then push the RESET button. 9. Confirm image capture, click on DONE and remove patient from unit.

9 9 of 17 Software Enhancing the Panoramic Image in Edit Mode 1. Use the custom Macro or an array of tools to enhance the image. 2. Click Save when you are satisfied with the image quality. Creating a full FMX from this one scan and applying it to the layout. 1. Click on Image Selection and Identify the first image.

10 10 of 17 Software 2. Click on Copy and then select Layout View to return to the layout. 3. Highlight the correct tile and click on Take/Retake From You now have your first PA in the corresponding tile position. 4. Repeat these steps 1 thru 3 to complete the remaining tiles, then click Save Congratulations you have completed a Full FMX from a single Pan image!

11 11 of 17 Panoramic X-Ray Examination Preparing the equipment (refer to fig.1 pg.12) Push button (27) Panoramic mode on the control remote. If Equipment not set is displayed and the relevant function LED blinks, push button (27) a second time in order to display the KV.70 setting and the SEC 17.0 setting for the Pan. Other messages that can be read during the Panoramic function setting on the control remote and the relevant actions to perform are as follows: 1. Digital Sensor not Ready: activate the Imaging program and wait for the completion of the initial check. 2. Select PAN: It is necessary to select PAN with button (13) positioned near the sensor. (refer to fig.2 pg.14) NOTE: THE SELECTION DONE ON THE HAND CONTROL MUST BE CONSISTENT WITH THE SELECTION DONE WITH THE BUTTONS ON THE PAN ITSELF AND ALSO ON THE IMAGING SOFTWARE. After completing the system SET UP, configure the chin support as follows: PANORAMIC Chin support Chin support PANORAMIC (1) SINUS (21) ADULT YES NO CHILD YES YES Programmed/Manual exposure The Imax-Easy can be operated in two different modes. You can choose whether to operate an exposure in a preset mode, meaning with the kv values are preprogrammed by the manufacturer OR operate an exposure in the manual mode, meaning you can change the preset kv values. Programmed exposure (refer to Fig.1 pg.12) Push buttons (33) for adult or (34) for child, operate with variations of kv and time. Push buttons (35) Large Size, (36) Medium Size or (37) Small Size, operate with variations on kv only. The following table shows the programmed values according to the selection made: Large Size Medium Size Small Size (35) (36) (37) ADULT (33) 0kV - 17sec 70kV - 17sec 65kV - 17sec CHILD (34) 65kV - 14sec 60kV - 14sec 60kV - 14sec Manual exposure (refer to Fig.1 pg.12) To manually select factors, follow the next procedure: 1. Push button (38) (kv), the button function will blink. 2. Push button (41) (increase) or (40) (decrease) on the remote control selecting the desired kv value to be used. After 2 seconds, the function button LED stops blinking. The unit is now ready for the next step. NOTE: The kv can vary from a minimum of 60kV to a maximum of 85kV in steps of 5kV. If, after having reached the minimum or maximum values of the kv range and additional decrease or increase is requested, the following messages will be displayed: Minimum or Maximum; the minimum or maximum set kv values will subsequently be displayed.

12 12 of 17 Remote Control Detail Figure 1: Remote Control 27. PAN mode Selection 36. Medium Size Selection 28. NOT ENABLED 37. Small Size Selection 29. TMJ1 mode Selection 38. kv Selection 30. TMJ2 mode Selection 39. Push-button Multifunctional 31. Test mode 40. Decrease kv 32. RESET 41. Increase kv 33. Adult Selection 42. X-rays push-button 34. Child Selection 43. X-rays emission pilot LED 35. Large Size Selection 44. Alphanumeric display

13 13 of 17 Panoramic Examination Preparing the patient (refer to fig.2 pg.14) 1. Ask the patient to remove all metal objects located in the radiography zone (necklaces, earrings, spectacles, hair-clips, movable dental plates etc.) Make sure that there are no heavy articles of clothing (such as overcoats, jackets, ties, polo-neck sweaters, etc.) in the radiography zone. 2. Have the patient put on the protecting apron or similar protective devices in accordance with the regulations in force in the various countries, making sure that it does not interfere with the trajectory of the X-rays beam. 3. Bring the patient in a standing position up to the chin support (1). While holding the handle (22), release the brake button (24), in order to vertically move the slider so that the chin support resting plane is aligned with the patient's chin. 4. Position the patient in the skull clamp (7) with the chin resting on the appropriate support and rest the hands on the side handles (22); have the patient bite with the incisors in the groove of the bite block (2) mounted on the appropriate rod, making sure both upper and lower anteriors are set in the groove of the bite piece. 5. Push the centering device activation button (20). When this is done, two crossed beams of light illuminate both the Sagittal median line (45) and the Frankfurt plane line (46). (refer to fig.3 pg.15) The centering device stays illuminated for about 40 seconds. If this time is insufficient to carry out the centering operations, the activation button (20) may be pressed again. 6. Bring the height of the skull-clamp, using knob (9), a little above the patient's orbital bone and center the patient until the position of perfect alignment with the Sagittal median line is obtained. The Frankfurt plane light beam must be adjusted for height in relation to the patient's size, the adjustment is made by acting on the appropriate knob (18). In order to check the patient's centering, the operator can tilt the mirror (6) towards himself, thus obtaining a front view of the patient. 7. Close the skull-clamp support (7), by acting on the appropriate knob (9). This will bring the supports into contact with the patient s temples and help the patient to hold the correct position during the examination. 8. After the head has been positioned, the patient has to make a movement with his feet towards the stand. This will give better distension of the spinal column in the cervical region, eliminating white ghosting of the spine on the radiograph in the zone of the lower incisors. 9. Check centering again, advise the patient to close mouth and eyes, ask then to swallow and bring the tongue against the palate and remain motionless for the exposure.

14 14 of 17 Panoramic Examination Figure 2: Panoramic position 1. PANORAMIC chin support 15. TMJ2 selection button 2. Bite Block 16. Rotating arm 3. Tubehead 17. Digital Sensor 6. Centering mirror 18. Horizontal light beam height control knob 7. Skull / Temple clamp support 20. Light cross beam button 9. Skull / Temple clamp control knob 21. Chin support TMJ, SINUS. 10. Motor group unit 22. Patient positioning handle and slider 11. Column 23. Support unit of the motor group 12. Slider 24. Brake release button 13. PAN selection button 25. Slot for Memory Card 14. TMJ1 selection button 26. Focus position point

15 15 of 17 Panoramic Examination Figure 3: Head Alignment 45. Sagittal median line 46. Frankfurt plane line Performing the exposure (refer to fig.2 pg.14) NOTE: During the emission of X-rays protection of the operator and surrounding personnel must be in accordance with the rules in force in the respective countries. The X-ray activation must always be commanded from an X-ray protected area via remote control. If it is necessary the operator must stand at a distance of at least 2 meters (6.6 feet) away from the X-ray source and, if possible, on the opposite direction. No other persons other than the operator and the patient, are allowed to stay in the examination room during the examination. 1. Check PAN Examination has been selected on the sensor with button. (13) 2. Check if the exposure settings are correct, press the X-ray button (42) during the whole time of the exposure, checking the simultaneous operation of the rays signaling light (43) and the acoustic ray signal. NOTE: The start of arm rotation and the emission of rays take place with a delay of four seconds after the activation of button (42). This allows preheating of the tube filament and confirmation of all the set values. 3. After exposure, the message Push Reset will be displayed, the patient may then be released from the positioning device. The return button (32) can now be pressed to move the machine back to the starting position. After full return, the message OK will be displayed, which will disappear when the button (32) is released. 4. With Reset operation performed, and with button (32) released the following message is displayed "Wait, please..." indicating a waiting time of 4 minutes to allow cooling of the tubehead anode. NOTE: After each examination, clean carefully both chin support and temple clamp and replace the bite.

16 16 of 17 TMJ Imaging NOTE: When performing TMJ examinations the x-ray emissions are not continuous, as it is interrupted during the transition phases between the different projections. The TMJ1 and TMJ2 examinations capture 2 different images each. The 4 images represent the right and left Condyle of the Temperomandibular Joint. (see below) The 2 outer images represent TMJ1 closed. The 2 center images represent TMJ2 open. We suggest following this operational sequence: TMJ1 followed by TMJ2. TMJ1 TMJ2 TMJ1 NOTE: The start of arm (16) rotation and the emission of rays take place with a delay of four seconds after the activation of button (42). This allows preheating of the tube filament and confirmation of all the set values. (refer to fig.4 pg.19) As discussed previously, the X-ray emission is not continuous for the full rotation, but it is interrupted, corresponding with the middle part of the mouth. As a result, both acoustic and visual emission signals are interrupted. This means that the arm s rotation will continue and then the emission signals will resume to complete the scan for both sides of the jaw.

17 17 of 17 TMJ1 Examination Preparing the equipment (refer to fig.1 pg.12) Push button (29) TMJ1 Mode on the remote control. If Equipment not set is displayed and the relevant function LED blinks, push button (29) a second time in order to display the KV.70 setting and the SEC 5.20 setting for the TMJ. Other messages that can be read during the panoramic function setting on the remote control and the relevant actions to perform are as follows: 1. Digital Sensor not Ready: Activate the Apteryx Imaging program and wait for the completion of the initial check. 2. Select TMJ1: It is necessary to select TMJ1 with button (14) positioned near the sensor. (refer to fig.4 pg.19) NOTE: THE SELECTION DONE ON THE REMOTE CONTROL MUST BE CONSISTENT WITH THE SELECTION DONE WITH THE BUTTONS ON THE PAN ITSELF AND ALSO ON THE IMAGING SOFTWARE. Complete the equipment preparation by removing the chin support for the panoramic examination (1) and replace it with the chin support for the sinus examination (21) (fig.4 pg.19) TMJ Chin support Chin support PANORAMIC (1) SINUS (21) ADULT NO YES CHILD NO YES Programmed/Manual exposure (refer to Fig.1 pg.12) The Imax-Easy can be operated in two different modes. You can choose whether to operate an exposure in a preset mode, meaning with the kv values are preprogrammed by the manufacturer or operate an exposure in the manual mode, meaning you can change the preset kv values. TMJ1 and 2 Large Size Medium Size Small Size (35) (36) (37) Adult (33) 80kV - 5,20sec 70kV - 5,20sec 65kV - 5,20sec Child (34) 65kV - 4,70sec 60kV - 4,70sec 60kV - 4,70sec The times reported in the table above are the sum of the exposure time for the right Condyle and the left Condyle, while the arm rotation time remains the same as the one reported for the panoramic examination.

18 18 of 17 TMJ1 Examination Preparing the patient (refer to fig.4 pg.19) 1. Ask the patient to remove all metal objects located in the radiography zone (necklaces, earrings, spectacles, hair-clips, movable dental plates etc.) Make sure that there are no heavy articles of clothing (such as overcoats, jackets, ties, polo-neck sweaters, etc.) in the radiography zone. 2. Have the patient put on the protecting apron or similar protective devices in accordance with the regulations in force in the various countries, making sure that it does not interfere with the trajectory of the X-rays beam. 3. Remove the bite block (2) from the positioning rod. Bring the patient in a standing position up to the chin support (21). While holding handle (22), push button (24) to release magnetic brake, in order to vertically move the slider so that the chin support resting plane is aligned with the patient's chin. 4. Position the patient in the skull-clamp (7) with the chin resting on the appropriate support and against the vertical positioning rod. Furthermore, position the hands on the handles (22). 5. Push the centering device activation button (20). When this is done, two crossed beams of light illuminate both the Sagittal median line (45) and the Frankfurt plane line (46). (refer to fig.4 pg.19) The centering device stays illuminated for about 40 seconds. If this time is insufficient to carry out the centering operations, the activation button (20) may be pressed again. 6. Move the height of the skull-clamp, vertically (9), a little above the patient's orbital bone and center the patient until perfect alignment with the Sagittal median line is obtained. The Frankfurt plane light beam must be adjusted for height in relation to the patient's size, the adjustment is made by acting on the appropriate knob (18). In order to check the patient's centering, the operator can tilt the mirror (6) towards himself, thus obtaining a front view of the patient. 7. Finally, close the skull-clamp support (7), by acting on the appropriate knob (9). This will bring the supports into contact with the patient s temples and help the patient to hold the correct position during the examination. 8. After the head has been positioned, the patient has to make a movement with his feet towards the stand. This will give better distension of the spinal column in the cervical region. 9. Check centering again, advise the patient to close mouth and eyes, ask then to swallow and bring the tongue against the palate and remain motionless for the exposure.

19 19 of 17 TMJ1 Examination Sagittal Frankfurt Figure 4: TMJ1 Position

20 20 of 17 TMJ1 Examination Performing the exposure (refer to fig.4 pg.19) 1. Check TMJ1 Examination has been selected on the sensor with button. (14) 2. The LED for button (29) on the remote, should be lit, check if the exposure data are correct, then press the X-ray button (42) during the whole time of the exposure. Check the simultaneous operation of the rays signaling light (43) and the acoustic ray signal. NOTE: The start of arm (16) rotation and the emission of rays take place with a delay of four seconds after the activation of button (42). This allows preheating of the tube filament and confirmation of all the set values. During TMJ examination, the X-ray emission is not continuous for the full rotation, but it is interrupted, corresponding with the middle part of the mouth. As a result, both acoustic and visual emission signals are interrupted. X-ray button (42) must be held down during the above emission interruption. This means that the arm s rotation will continue and then the emission signals will resume, in order to complete the scan for both sides of the jaw. NOTE: In case the patient moves during the arm s rotation, the exam must be restarted to insure proper image quality. Releasing the x-ray button (42) will stop both emission and rotation. The message Press Reset will appear on the remote control display. Push button (32) to reset the arm to the home position. Once the arm has reached home position, the OK message will be displayed, release button. Reset the Apteryx Imaging program for the execution of a new radiography and restart the scan. Once the full TMJ1 scan is completed, reset (32) the machine, and prepare the equipment and the patient for the TMJ2 scan.

21 21 of 17 TMJ2 Examination Preparing the equipment (refer to fig.1 pg.12) Push button (30) TMJ2 Mode on the remote control. If Equipment not set is displayed and the relevant function LED blinks, push button (30) a second time in order to display the KV.70 setting and the SEC 5.20 setting for the TMJ. Other messages that can be read during the panoramic function setting on the remote control and the relevant actions to perform are as follows: 1. Digital Sensor not Ready: activate the QuickVision program and wait for the completion of the initial check. 2. Select TMJ2: it is necessary to select TMJ2 with the dedicated button (15) positioned near the sensor. (refer to fig.5 pg.22) NOTE: THE SELECTION DONE ON THE HAND CONTROL MUST BE CONSISTENT WITH THE SELECTION DONE WITH THE BUTTONS POSITIONED IN THE AREA OF THE DIGITAL SENSOR. TMJ2 examination Preparing the patient (refer to fig.5 pg.22) 1. Open the skull-clamp support (7) by adjusting the appropriate knob (9). 2. Instruct the patient to open the mouth as far as possible, maintaining the mandible fixed and flat on the support. The patient s chin must stay forward against the vertical part of the chin support (21). As a result, the patient s head will be slightly rotated backward. 3. Push the centering device activation button (20). When this is done, two crossed beams of light illuminate both the Sagittal median line (45) and the Frankfurt plane line (46). (refer to fig.5 pg.22) The centering device stays illuminated for about 40 seconds. If this time is insufficient to carry out the centering operations, the activation button (20) may be pressed again. In order to check the patient s centering, operator can tilt the mirror (6) towards himself, thus obtaining a front view of the patient. 4. Once the patient is centered, close the skull-clamp support (7), by acting on the appropriate knob (9). This will bring the supports into contact with the patient s temples and help the patient hold the correct position during the examination.

22 22 of 17 TMJ2 Examination Sagittal Frankfurt Figure 5: TMJ2 Position

23 23 of 17 TMJ2 Examination Performing the exposure (refer to fig.5 pg.22) 1. Check TMJ1 Examination has been selected on the sensor with button. (15) 2. The LED for button (30) on the remote, should be lit, check if the exposure data are correct, then press the X-ray button (42) during the whole time of the exposure. Check the simultaneous operation of the rays signaling light (43) and the acoustic ray signal. NOTE: The start of arm (16) rotation and the emission of rays take place with a delay of four seconds after the activation of button (42). This allows preheating of the tube filament and confirmation of all the set values. During TMJ examination, the X-ray emission is not continuous for the full rotation, but it is interrupted, corresponding with the middle part of the mouth. As a result, both acoustic and visual emission signals are interrupted. X-ray button (42) must be held down during the above emission interruption. This means that the arm s rotation will continue and then the emission signals will resume, in order to complete the scan for both sides of the jaw. NOTE: In case the patient moves during the arm s rotation, the exam must be restarted to insure proper image quality. Releasing the x-ray button (42) will stop both emission and rotation. The message Press Reset will appear on the remote control display. Push button (32) to reset the arm to the home position. Once the arm has reached home position, the OK message will be displayed, release button. Reset the Apteryx Imaging program for the execution of a new radiography and restart the scan. Sinus Examination The SINUS examination aim is to show the structure located in the sinomaxillary area. Preparing the equipment The equipment setting is like the one described for panoramic examination. The only difference between the panoramic setup and the sinus setup is due to the different chin support used. Sinus Chin support Chin support PANORAMIC (1) SINUS (21) ADULT NO YES CHILD NO YES Programmed/Manual exposure The kv and Time (seconds) parameters in sinus setup are like the panoramic ones. Preparing the patient 1. Positioning for the sinus examination is identical to the panoramic examination, except there is no need for the bite block. The patient should have mouth closed. Performing the exposure 1. Proceed with exposure just like a panoramic examination.

24 24 of 17 Supply Order Information You will want to order enough supplies to equip all your treatment rooms prior to your training session so you can operate immediately following your training session. Onsite trainers do not provide supplies. Ref. Order code Description Kit for 500 Centering clamp Kit for 50 Centering clamp rod Panoramic chin support SINUS chin support Round centering tool Fluorescent screen for X-ray beam centering

25 25 of 17 Assignment Practice Session Following is the routine each staff member must learn before taking images on a live patient. 1. Open Apteryx from both the Practice Mgt. software and the desktop icon. 2. Enter a staff member into the program as a new patient. 3. Set up unit for a small size Adult (50kV) 4. Confirm proper patient positioning. 5. Take a single Panoramic image on this patient. 6. Use the enhancement tools to modify the image. 7. If image is unsatisfactory set up for retake. Use Troubleshoot guide to correct for positioning errors and retake in the current layout. 8. Create a Full FMX from this image using Apteryx. 9. Take a TMJ1 and TMJ2 image on this patient. 10.Take a Re-Take bitewing in the FMX series. 11. Print out the full FMX Series on one sheet. 12. Close current patient and reopen a new one. Live Session Going live with patients should only be performed by staff who have participated, and comfortable, with the above training routine. Your staff should practice on each other before patients. Your trainer will assist each staff member with their first patient. Front Desk Session Printing Images Scanning Images Working with Micro Soft Word Documents